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Bulletin de Parrainage
Ce formulaire vous permet de finaliser votre proposition de parrainage d'un animal sauvé par Urgence Maltraitance Animale.
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Email
*
Your email
Nom
*
Your answer
Prénom
*
Your answer
Adresse
*
Your answer
Téléphone
*
Your answer
Date de naissance
*
MM
/
DD
/
YYYY
Pseudo Facebook
Your answer
Je souhaite parrainer :
*
un chien
un chat
un NAC
un équidé
un animal de ferme
Nom de l'animal
*
Your answer
N° d'identification
Your answer
Montant du parrainage (10€/mois minimum)
*
Your answer
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